Towards effective cancer management in Nigeria
The annual World Cancer Day was marked on 4 February, 2015. The goal was to intensify awareness campaign on the disease, as well as discuss new methods of curbing it. This year’s theme, ‘Not beyond us’, gives hope to cancer patients and their relatives, as it implies the possibility of cancer remedies across the globe and within our reach.
According to a report on World Cancer Day 2015, the campaign will explore the implementation of existing preventive measures, early detection, treatment and care, and in turn, open up to the exciting prospect that can impact the global cancer burden – for the better. Four key areas will constitute the focal point of the campaign, which are: choosing healthy lives; delivering early detection; achieving treatment for all; and maximising quality of life.
If all stakeholders would give this crusade all it takes to be a success, the alarming rate of 100,000 new cases of cancer recorded annually in the country will be drastically reduced.
A professor of radiotherapy and Oncology with the College of Medicine, University of Lagos, Akoka, Aderemi Ajekigbe, had while leading a campaign against cancer in January, asserted that Nigeria records 100,000 new cases of cancer annually. He added that except a timely intervention of government occurs, through the provision of functioning radiotherapy machines across the country, more cases will be recorded.
Ajekigbe attributed the increasing rate of the disease in developing countries like Nigeria to the poor state of health facilities, poor funding of cancer care, late diagnosis and detection of the deadly disease in the country. He emphasised the need for government to play a major role in the crusade as there are many poor Nigerians groaning under the pain of cancer, who cannot afford the treatment option.
“We cannot afford to lose more Nigerians to cancer. Government should dedicate the proceeds from an oil block to the provision of cancer equipment and treatment. It is a need,” he said.
What is cancer?
Cancer is a class of diseases characterised by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected.
Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumours (except in the case of leukaemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumours can grow and interfere with the digestive, nervous, and circulatory systems and they can release hormones that alter body function. Tumours that stay in one spot and demonstrate limited growth are generally considered to be benign.
More dangerous or malignant tumours form when two things occur:
- a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion
- that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis.
When a tumour successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.
Symptoms of cancer
- Persistent cough or hoarseness. While a cough here and there is nothing to worry about, a consistent cacophony or a cough accompanied by blood is definitely a cause for concern. “Most coughs are not cancer,” says Therese Bartholomew Bevers, M.D., professor of clinical cancer prevention and the medical director of the Cancer Prevention Centre at the MD Anderson Cancer Centre. “But certainly a persistent cough needs to be evaluated to see if it could be lung cancer.” Your physician should recommend a chest X-ray or CT scan to rule out cancer as a possibility.
- Persistent change in bowel habits. When your bowel movements aren’t as easy as they once were or your stool appears larger than normal or somewhat deformed, this could be a sign of colon cancer, says Bartholomew Bevers. “It could be a sign that there is a mass impeding the transit of the stool from the bowel,” she says. “This is a symptom where a person should go to the doctor and schedule a colonoscopy to see if there indeed is a mass.”
- Persistent change in bladder habits. “If there is blood in the urine, that could be indicative of bladder or kidney cancer—but more commonly this is a sign of a urinary tract infection,” says Bartholomew Bevers. Check for an infection first, then pursue other treatment options.
- Persistent unexplained pain. “Most pain is not a sign of cancer, but persistent pain must be checked out,” says Bartholomew Bevers. “If you have persistent headaches, for example, you likely don’t have brain cancer—but it is still something that must be looked into. Persistent pain in the chest could be a sign of lung cancer. And pain in your abdomen could be ovarian cancer.”
- Change in the appearance of a mole. While not all moles are indicative of melanoma, spotting a new mark or one that has changed is something you should bring up with a dermatologist who can screen for skin cancer, says Bartholomew Bevers.
- A sore that does not heal. If you have a sore that’s hanging on past the three-week mark, you should bring it up with your doctor. “We would have expected our body to have healed itself by now,” says Bartholomew Bevers, “and you should absolutely get that checked out.” That kind of sore could be a sign of carcinoma.
- Unexpected Bleeding. Vaginal bleeding—outside of your normal cycle—could be an early sign of cervical cancer, while bleeding from the rectum could indicate colon cancer, says Bartholomew Bevers.
- Unexplained weight loss. “As adults, we try very hard to lose weight,” says Bartholomew Bevers. “But if weight is falling off of you without any effort on your part, that is a big concern and can be indicative of a serious medical problem.” One of those problems, she says, could be malignancy or a tumour.
- An unexplained lump. “Any time you have a lump that is new or a lump that is changing, that is something you should absolutely have looked at by your doctor,” says Bartholomew Bevers. While it could be a benign cyst (and likely is), it could also be “a cancer that is in the subterranean tissue. A lump in the chest, of course, is a very common symptom of chest cancer.” See your physician to get more information.
How is cancer classified?
There are five broad groups that are used to classify cancer.
- Carcinomas are characterised by cells that cover internal and external parts of the body such as lung, breast, and colon cancer.
- Sarcomas are characterised by cells that are located in bone, cartilage, fat, connective tissue, muscle, and other supportive tissues.
- Lymphomas are cancers that begin in the lymph nodes and immune system tissues.
- Leukaemias are cancers that begin in the bone marrow and often accumulate in the bloodstream.
- Adenomas are cancers that arise in the thyroid, the pituitary gland, the adrenal gland, and other glandular tissues.
Cancers are often referred to by terms that contain a prefix related to the cell type in which the cancer originated and a suffix such as -sarcoma, -carcinoma, or just -oma. Common prefixes include:
* Adeno- = gland
* Chondro- = cartilage
* Erythro- = red blood cell
* Hemangio- = blood vessels
* Hepato- = liver
* Lipo- = fat
* Lympho- = white blood cell
* Melano- = pigment cell
* Myelo- = bone marrow
* Myo- = muscle
* Osteo- = bone
* Uro- = bladder
* Retino- = eye
* Neuro- = brain
How fast does cancer spread?
Scientists reported in Nature Communications that they have discovered an important clue as to why cancer cells spread. It has something to do with their adhesion (stickiness) properties. Certain molecular interactions between cells and the scaffolding that holds them in place (extracellular matrix) cause them to become unstuck at the original tumour site, they become dislodged, move on and then reattach themselves at a new site.
The researchers say this discovery is important because cancer mortality is mainly due to metastatic tumours, those that grow from cells that have travelled from their original site to another part of the body. Only 10 per cent of cancer deaths are caused by the primary tumours.
The scientists, from the Massachusetts Institute of Technology, say that finding a way to stop cancer cells from sticking to new sites could interfere with metastatic disease, and halt the growth of secondary tumours.
In 2007, cancer claimed the lives of about 7.6 million people in the world. Physicians and researchers who specialise in the study, diagnosis, treatment, and prevention of cancer are called oncologists.
Malignant cells are more agile than non-malignant ones. Scientists from the Physical Sciences-Oncology Centers, USA, reported in the journal Scientific Reports (April 2013 issue) that malignant cells are much “nimbler” than non-malignant ones. Malignant cells can pass more easily through smaller gaps, as well as applying a much greater force on their environment compared to other cells.
Professor Robert Austin and team created a new catalogue of the physical and chemical features of cancerous cells with over 100 scientists from 20 different centres across the United States. The authors believe their catalogue will help oncologists detect cancerous cells in patients early on, thus preventing the spread of the disease to other parts of the body.
Prof. Austin said. “By bringing together different types of experimental expertise to systematically compare metastatic and non-metastatic cells, we have advanced our knowledge of how metastasis occurs.”
How is cancer diagnosed and staged?
Early detection of cancer can greatly improve the odds of successful treatment and survival. Physicians use information from symptoms and several other procedures to diagnose cancer. Imaging techniques such as X-rays, CT scans, MRI scans, PET scans, and ultrasound scans are used regularly in order to detect where a tumour is located and what organs may be affected by it. Doctors may also conduct an endoscopy, which is a procedure that uses a thin tube with a camera and light at one end, to look for abnormalities inside the body.
Extracting cancer cells and looking at them under a microscope is the only absolute way to diagnose cancer. This procedure is called a biopsy. Other types of molecular diagnostic tests are frequently employed as well. Physicians will analyse your body’s sugars, fats, proteins, and DNA at the molecular level. For example, cancerous prostate cells release a higher level of a chemical called PSA (prostate-specific antigen) into the bloodstream that can be detected by a blood test. Molecular diagnostics, biopsies, and imaging techniques are all used together to diagnose cancer.
How can cancer treated?
Cancer treatment depends on the type of cancer, the stage of the cancer (how much it has spread), age, health status, and additional personal characteristics. There is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.
Surgery is the oldest known treatment for cancer. If a cancer has not metastasised, it is possible to completely cure a patient by surgically removing the cancer from the body. This is often seen in the removal of the prostate or a breast or testicle. After the disease has spread, however, it is nearly impossible to remove all of the cancer cells. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression.
Innovations continue to be developed to aid the surgical process, such as the iKnife that “sniffs” out cancer. Currently, when a tumour is removed surgeons also take out a “margin” of healthy tissue to make sure no malignant cells are left behind. This usually means keeping the patients under general anaesthetic for an extra 30 minutes while tissue samples are tested in the lab for “clear margins”. If there are no clear margins, the surgeon has to go back in and remove more tissue (if possible). Scientists from Imperial College London say the iKnife may remove the need for sending samples to the lab.
Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Radiotherapy utilises high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used as a standalone treatment to shrink a tumour or destroy cancer cells (including those associated with leukaemia and lymphoma), and it is also used in combination with other cancer treatments.
Chemotherapy utilises chemicals that interfere with the cell division process – damaging proteins or DNA – so that cancer cells will commit suicide. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasised because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukaemia and lymphoma. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting. Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options.
Immunotherapy aims to get the body’s immune system to fight the tumour. Local immunotherapy injects a treatment into an affected area, for example, to cause inflammation that causes a tumour to shrink. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumours. Immunotherapy can also be considered non-specific if it improves cancer-fighting abilities by stimulating the entire immune system, and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. These therapies are relatively young, but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. Bone marrow transplantation (hematopoietic stem cell transplantation) can also be considered immunotherapy because the donor’s immune cells will often attack the tumour or cancer cells that are present in the host.
Several cancers have been linked to some types of hormones, most notably breast and prostate cancer. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Breast cancer hormone therapies often focus on reducing estrogenic levels (a common drug for this is tamoxifen) and prostate cancer hormone therapies often focus on reducing testosterone levels. In addition, some leukaemia and lymphoma cases can be treated with the hormone cortisone.
The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. For example, researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell commits suicide. Gene therapy is a very young field and has not yet resulted in any successful treatments.
Using cancer-specific immune system cells to treat cancer
Scientists from the RIKEN Research Centre for Allergy and Immunology in Yokohama, Japan, explained in the journal Cell Stem Cell (January 2013 issue) how they managed to make cancer-specific immune system cells from iPSCs (induced pluripotent stem cells) to destroy cancer cells.
The authors added that their study has shown that it is possible to clone versions of the patients’ own cells to enhance their immune system so that cancer cells could be destroyed naturally.
Hiroshi Kawamoto and team created cancer-specific killer T-lymphocytes from iPSCs. They started off with mature T-lymphocytes which were specific for a type of skin cancer and reprogrammed them into iPSCs with the help of “Yamanaka factors”. The iPSCs eventually turned into fully active, cancer-specific T-lymphocytes – in other words, cells that target and destroy cancer cells.
How can cancer be prevented?
Cancers that are closely linked to certain behaviours are the easiest to prevent. For example, choosing not to smoke tobacco or drink alcohol significantly lowers the risk of several types of cancer – most notably lung, throat, mouth, and liver cancer. Even if you are a current tobacco user, quitting can still greatly reduce your chances of getting cancer.
Skin cancer can be prevented by staying in the shade, protecting yourself with a hat and shirt when in the sun, and using sunscreen. Diet is also an important part of cancer prevention since what we eat has been linked to the disease. Physicians recommend diets that are low in fat and rich in fresh fruits and vegetables and whole grains.
Certain vaccinations have been associated with the prevention of some cancers. For example, many women receive a vaccination for the human papillomavirus because of the virus’s relationship with cervical cancer. Hepatitis B vaccines prevent the hepatitis B virus, which can cause liver cancer.
Some cancer prevention is based on systematic screening in order to detect small irregularities or tumours as early as possible even if there are no clear symptoms present. Breast self-examination, mammograms, testicular self-examination, and Pap smears are common screening methods for various cancers.
Researchers from Northwestern University Feinberg School of Medicine in Chicago reported in the journal Circulation that the 7 steps recommended for protection against heart disease can also reduce the risk of developing cancer,. They include being physically active, eating a healthy diet, controlling cholesterol, managing blood pressure, reducing blood sugar and not smoking.
Other means of combating cancer
Exercise and cancer
Exercise can help control fatigue, muscle tension, and anxiety in those with cancer. Patients tend to feel better if they do exercises such as walking or swimming. Exercise has also been shown to improve the outcomes associated with cancer treatment.
Mind/body medicine for cancer
Some mind/body therapies improve quality of life for cancer patients through behaviour modification; others encourage expression of emotions. Behaviour therapies such as guided imagery, progressive muscle relaxation, hypnotherapy, and biofeedback are used to alleviate pain, nausea, vomiting, and the anxiety that may occur in anticipation of, or after, cancer treatment. Individual or group counselling allows patients to confront problems and emotions caused by cancer and receive support from fellow patients in a group setting. Patients who pursue these types of therapies tend to feel less lonely, less anxious about the future, and more optimistic about recovery.
Nutrition, diet, and cancer
Scientific evidence suggests that nutrition may play a role in cancer prevention. Observational studies have shown that cancer is more common in some people with certain dietary habits — such as colorectal cancer in people who have diets rich in meat products. So far, data has not supported the use of any vitamins or supplements to decrease the risk of cancer. In fact, studies show some supplements may increase cancer risk, such as lung cancer risk in smokers taking beta carotene and prostate cancer risk in men taking high doses of vitamin E.
Also, experts don’t recommend stopping standard treatment in place of complementary medicine, but many therapies can help people with cancer feel better.
Acupuncture and acupressure
Acupuncture and acupressure are examples of “complementary” medicine for cancer. While neither claims to cure the disease, some evidence shows that they help reduce symptoms and side effects of the illness and its treatment.
* Join a cancer support group.
* Get plenty of rest, balanced with light exercise.
* Rather than feeling compelled to maintain a “positive attitude,” express your emotions honestly. Don’t worry if you sometimes feel depressed or afraid: These are normal feelings and legitimate reactions that will not affect your cancer.
* Fill your days with activities you enjoy. Reading a good book, listening to music, and talking with friends are surprisingly therapeutic.
Report compiled by Temitope Obayendo with additional information from:
WebMD Medical Reference; World Cancer Day 2015; womenshealthmag.com